Recanalization Treatments for Pediatric Acute Ischemic Stroke in France
Authors: Manoëlle Kossorotoff, Basile Kerleroux, Grégoire Boulouis, Béatrice Husson, Kim Tran Dong, François Eugene, Lena Damaj, Augustin Ozanne, Céline Bellesme, Anne Rolland, Romain Bourcier, Aude Triquenot-Bagan, Gaultier Marnat, Jean-Philippe Neau, Sylvie Joriot, Alexandra Perez, Maud Guillen, Maximilien Perivier, Frederique Audic, Jean François Hak, Christian Denier, Olivier Naggara, WAGIH BEN HASSEN, MANOËLLE KOSSOROTOFF, OLIVIER NAGGARA, BASILE KERLEROUX, CHRISTIAN DENIER, AUGUSTIN OZANNE, CÉLINE BELLESME, BÉATRICE HUSSON, CHABRIAT HUGUES, REINER PEGGY, CATHERINE LAMY, FREDERIC CLARENÇON, SANDRINE DELTOUR, MICHÈLE LEVASSEUR, FRANÇOIS LUN, HASSAN HOSSEINI, ADRIEN VILLAIN, CHANTAL LAMY, LOÏC HERY, CYRIL CHIVOT, SOPHIE GUEDEN, BENJAMIN BOUAMRA, JOANNA BELLEVILLE GOFFENEY, ALESSANDRA BIONDI, PAULINE RENOU, MARIE THIBAUD, GAULTIER MARNAT, NATHALIE BACH, ANNA FERRIER, GANAELLE REMERAND, EMMANUEL CHABERT, YANNICK BÉJOT, OLIVIER DETANTE, ELODIE LAMETERY, FLORENCE TAHON, CHARLOTTE CORDONNIER, JORIOT SYLVIE, KAZEMI APOLLINE, CECILE LAROCHE, SUZANA SALEME, LAURENT DEREX, MARYLINE CARNEIRO, OMER EKER, FREDERIQUE AUDIC, PHILIPPE DORY LAUTREC, NADINE GIRARD, CAROLINE ARQUIZAN, PIERRE MEYER, SEBASTIEN RICHARD, CLAIRE BILBAULT, HUBERT DESAL, ANNE ROLLAND, BOURCIER ROMAIN, EMMANUELLE GONDON, JACQUES SEDAT, PASCAL AUZOU, CANAN OZSANCAK, GUILLAUME CAMI, JEAN PHILIPPE NEAU, NICOLAS RAYNAUD, STÉPHANE VELASCO, STEPHANE VANNIER, LÉNA DAMAJ, JEAN CHRISOPHE FERRÉ, FRANCOIS EUGENE, AUDE TRIQUENOT BAGAN, CHRISANTHI PAPAGIANNAKI, VALÉRIE WOLFF, ALEXANDRA PEREZ, RÉMY BEAUJEUX, EMMANUEL CHEURET, JEAN DARCOURT, KEVIN JANOT, MAXIMILIEN PERIVIER, DENIS HERBRETEAUX
Journal: JAMA Network Open (2022)

There is to date limited evidence that revascularization strategies are associated with improved functional outcome in children with acute ischemic stroke (AIS).To report clinical outcomes and provide estimates of revascularization strategy safety and efficacy profiles of intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) in children with AIS.The KidClot multicenter nationwide cohort study retrospectively collected data of children (neonates excluded) with AIS and recanalization treatment between January 1, 2015, and May 31, 2018. Data analysis was performed from January 1, 2015, to May 31, 2019.IVT and/or EVT.Primary outcome was day 90 favorable outcome (modified Rankin Scale [mRs] 0-2, with 0 indicating no symptoms and 6 indicating death). Secondary end points included 1-year favorable outcome (mRs, 0-2), mortality, and symptomatic intracerebral hemorrhage. Other measures included the Pediatric National Institutes of Health Stroke Scale (pedNIHSS), with pedNIHSS 0 indicating no symptoms, 1 to 4 corresponding to a minor stroke, 5 to 15 corresponding to a mild stroke, greater than 15 to 20: severe stroke, and the adult Alberta Stroke Program Early CT Score (ASPECTS), which provides segmental assessment of the vascular territory, with 1 point deducted from the initial score of 10 for every region involved (from 10 [no lesion] to 0 [maximum lesions]).Overall, 68 children were included in 30 centers (IVT [n = 44]; EVT [n = 40]; 44 boys [64.7%]; median [IQR] age, 11 [4-16] years; anterior circulation involvement, 57 [83.8%]). Median (IQR) pedNIHSS score at admission was 13 (7-19), higher in the EVT group at 16 (IQR, 10-20) vs 9 (6-17) in the IVT only group (P < .01). Median time from stroke onset to imaging was higher in the EVT group at 3 hours and 7 minutes (IQR, 2 hours and 3 minutes to 6 hours and 24 minutes) vs 2 hours and 39 minutes (IQR, 1 hour and 51 minutes to 4 hours and 13 minutes) (P = .04). Median admission ASPECTS score was 8 (IQR, 6-9). The main stroke etiologies were cardioembolic (21 [30.9%]) and focal cerebral arteriopathy (17 [25.0%]). Median (IQR) time from stroke onset to IVT was 3 hours and 30 minutes (IQR, 2 hours and 33 minutes to 4 hours and 28 minutes). In the EVT group, the rate of postprocedure successful reperfusion (≥modified Treatment in Cerebral Infarction 2b) was 80.0% (32 of 40). Persistent proximal arterial stenosis was more frequent in focal cerebral arteriopathy (P < .01). Death occurred in 3 patients (4.4%). Median pedNIHSS reduction at 24 hours was 4 (IQR, 0-9) points. Intracerebral hemorrhage occurred in 4 patients and symptomatic intracerebral hemorrhage occurred in 1 patient, all in the EVT group. The median mRS was 2 (IQR, 0-3) at day 90 and 1 (IQR, 0-2) at 1 year, which was not significantly different between EVT and IVT only groups, although different in initial severity.The findings of this cohort study suggest that use of EVT and/or IVT is safe in children with AIS.